Biomarkers Score for Patients with Mitral Stenosis: A useful conjunction with Wilkins’s Score for Early Intervention
DOI:
https://doi.org/10.17140/HROJ-2-121Keywords:
Wilkins’s score; Biomarkers score, Mitral stenosis; ValvuloplastyAbstract
Objective: We proposed a novel new insight independent score of Mitral Stenosis (MS) based
on elevated biomarkers.
Subjects and Methods: One hundred sixty-eight patients with MS candidate for Percutanous
balloon valvuloplasty (PBMV) were included in the study. Brain Natriurectic Peptide (BNP),
Tenascin-C (TN-C), copeptin and high-sensitive C-reactive protein (hs-CRP) were measured
before PBMV. The cut-off value of each biomarker for prediction of systolic pulmonary artery
pressure >50 mm Hg was calculated. Two points were given to a value ≥cut-off value and one
point if less. Summation of points gave the biomarkers score.
Results: A biomarker score cut-off value ≥5.2 had a sensitivity of 83.6%, a specificity of 82.9%
(AUC=0.85), in predicting cardiac events after successful PBMV. The Wilkins’s score of ≥6.5
had a sensitivity of 73.5%, a specificity of 79.2% (AUC=0.80). The conjunction of Wilkins’s
score with biomarker score have higher predicting power (AUC=97%). The correlation co-efficient
of biomarker score was (r=0.755), greater than that of the Wilkin’s score (r=0.613). The
combined biomarkers and Wilkins’s score showed the strongest correlation with cardiac events
(r=0.911). In multiple regression analysis, the regression co-efficient of biomarker score versus
Wilkin’s score was (0.595 versus 0.364), and the combined scores had the strongest powerful
independent predictor of cardiac events (r=0.825).
Conclusions: In patients with MS especially asymptomatic patients, biomarker risk score that
included BNP, tenacin-c, copeptin and hs-CRP and, had a good correlation with clinical outcomes
after successful PBMV, and the conjunction of the biomarkers score and Wilkin’s score
provided higher prognostic value.
References
Olesen KH. The natural history of 271 patients with mitral stenosis under medical treatment. Br Heart J. 1962; 349-357.
Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvu-lar heart diseases: a population based study. Lancet. 2006; 368: 1005-1011. doi: 10.1016/S0140-6736(06)69208-8
Narin N, Kütükçüler N, Ozyürek R, Bakiler AR, Parlar A, Ar-casoy M. Lymphocyte subsets and plasma IL-1 alpha, IL-2, and TNF-alpha concentrations in acute rheumatic fever and chronic rheumatic heart disease. Clin Immunol Immunopathol. 1995; 77: 172-176.
Morris K, Mohan C, Wahi PL, Anand IS, Ganguly NK. En-hancement of IL-1, IL-2 production and IL-2 receptor genera-tion in patients with acute rheumatic fever and active rheumatic heart disease; a prospective study. Clin Exp Immunol. 1993; 91: 429-436. doi: 10.1111/j.1365-2249.1993.tb05920.x
Sharma V, Stewart RA, Zeng I, Raffel C, Kerr AJ. Compari-son of atrial and brain natriuretic peptide for the assessment of mitral stenosis. Heart, Lung and Circulation. 2011; 20: 517-524. doi: 10.1016/j.hlc.2011.03.112
Pan M, Medina A, Suarez de Lezo J, et al. Factors determin-ing late success after mitral balloon valvulotomy. Am J Cardiol. 1993; 71: 1181-1185. doi: 10.1016/0002-9149(93)90643-Q
Steadman CD, Ray S, Ng LL, McCann GP. Natriuretic pep-tides in common valvular heart disease. JACC. 2010; 55(19): 2034-2048. doi: 10.1016/j.jacc.2010.02.021
Polyakova V, Hein S, Kostin S, Ziegelhoeffer T, Schaper J. Matrix metalloproteinases and their tissue inhibitors in pressure-overloaded human myocardium during heart failure progres-sion. J Am Coll Cardiol. 2004; 44: 1609-1618. doi: 10.1016/j. jacc.2004.07.023
Tamaoki M, Imanaka-Yoshida K, Yokoyama K, et al. Tenas-cin-C regulates recruitment of myofibroblasts during tissue re-pair after myocardial injury. Am J Pathol. 2005; 167: 71-80. doi:
1016/S0002-9440(10)62954-9 10. Wilkins GT, Weyman AE, Abascal VM, et al. Percutaneous balloon dilatation of the mitral valve: An analysis of echocardio-graphic variables related to outcome and the mechanism of dila-tation. Br Heart J. 1988; 60: 299-308. doi: 10.1136/hrt.60.4.299
Song JK, Song JM, Kang DH, et al. Restenosis and adverse clinical events after successful percutaneous mitral valvuloplas-ty: immediate post-procedural mitral valve area as an important prognosticator. Eur Heart J. 2009; 30: 1254-1262. doi: 10.1093/ eurheartj/ehp096
Braverman AC, Thomas JD, Lee RT. Doppler echocardio-graphic estimation of mitral valve area during changing hemo-dynamic conditions. Am J Cardiol. 1991; 68: 1485-1490. doi: 10.1016/0002-9149(91)90283-Q
Günebakmaz Ö, Celik A, Inanc T, et al. Copeptin level and copeptin response to percutaneous balloon mitral valvulo-plasty in mitral stenosis. Cardiology. 2011; 120: 221-226. doi: 10.1159/000335888
Iltumur K, Karabulut A, Yokus B, Yavuzkir M, Taskesen T, Toprak N. N-terminal proBNP plasma levels correlate with se-verity of mitral stenosis. J Heart Valve Dis. 2005; 14: 735-741.
Jiang L, Wei XF, Yi DH, et al. Synergistic effects of cyclic strain and Th1-like cytokines on tenascin-C production by rheu-matic aortic valve interstitial cells. Clin Exp Immunol. 2009; 155: 216-223. doi: 10.1111/j.1365-2249.2008.03747.x
Morgenthaler NG, Struck J, Alonso C, Bergmann A. Assay for the measurement of copeptin, a stable peptide derived from the precursor of vasopressin. Clin Chem. 2006; 52: 112-119. doi: 10.1373/clinchem.2005.060038
Celik A, Kocyigit I, Calapkorur B, et al. Tenascin-C may be a predictor of acute pulmonary thromboembolism. J Atheroscler Thromb. 2011; 18: 487-493.
Schumann C, Lepper PM, Frank H, et al. Circulating biomark-ers of tissue remodelling in pulmonary hypertension. Biomark-ers. 2010; 15: 523-532. doi: 10.3109/1354750X.2010.492431
Jones PL, Cowan KN, Rabinovitch M. Tenascin-C, prolif-eration and subendothelial fibronectin in progressive pulmonary vascular disease. Am J Pathol. 1997; 150: 1349-1360.
Jian B, Jones PL, Li Q, Mohler ER 3rd, Schoen FJ, Levy RJ. Matrix metalloproteinase-2 is associated with tenascin-C in calcific aortic stenosis. Am J Pathol. 2001; 159: 321-327. doi: 10.1016/S0002-9440(10)61698-7
Celik A, Gunebakmaz O, Baran O, et al. An investigation of tenascin-c levels in rheumatic mitral stenosis and their response to percutaneous mitral balloon valvuloplasty. Med Princ Pract. 2013; 22: 29-34. doi: 10.1159/000340061
Palacios IF, Sanchez PL, Harrell LC, Weyman AE, Block PC. Which patients benefit from percutaneous mitral balloon valvuloplasty? Prevalvuloplasty and postvalvuloplasty variables that predict long-term outcome. Circulation. 2002; 105: 1465- 1471. doi: 10.1161/01.CIR.0000012143.27196.F4
Meneveau N, Schiele F, Seronde MF, et al. Predictors of event-free survival after percutaneous mitral commissurotomy. Heart. 1998; 80: 359-364.
Fawzy ME, Hegazy H, Shoukri M, El Shaer F, ElDali A, Al-Amri M. Long-term clinical and echocardiographic results after successful mitral balloon valvotomy and predictors of long-term outcome. Eur Heart J. 2005; 26: 1647-1652. doi: 10.1093/eur-heartj/ehi226
Zimmet AD, Almeida AA, Harper RW, et al. Predictors of surgery after percutaneous mitral valvuloplasty. Ann Thorac Surg. 2006; 82: 828-833. doi: 10.1016/j.athoracsur.2006.03.096
Ribeiro PA, al Zaibag M, Abdullah M. Pulmonary artery pressure and pulmonary vascular resistance before and after mi-tral balloon valvotomy in 100 patients with severe mitral valve stenosis. Am Heart J. 1993; 125: 1110-1114.
Hart SA, Krasuski RA, Wang A, Kisslo K, Harrison JK, Bashore TM. Pulmonary hypertension and elevated transpulmo-nary gradient in patients with mitral stenosis. J Heart Valve Dis. 2010; 19: 708-715.
Dev V, Shrivastava S. Time course of changes in pulmonary vascular resistance and the mechanism of regression of pulmo-nary arterial hypertension after balloon mitral valvuloplasty. Am J Cardiol. 1991; 67: 439-442.
Boldt A, Wetzel U, Lauschke J, et al. Fibrosis in left atrial tis-sue of patients with atrial fibrillation with and without underly-ing mitral valve disease. Heart. 2004; 90: 400-405. doi: 10.1136/ hrt.2003.015347
Neuhold S, Huelsmann M, Strunk G, et al. Comparison of copeptin, B-type natriuretic peptide, and amino-terminal pro-B-type natriuretic peptide in patients with chronic heart failure: prediction of death at different stages of the disease. J Am Coll Cardiol. 2008; 52: 266-272. doi: 10.1016/j.jacc.2008.03.050
Palacios IF, Tuzcu ME, Weyman AE, Newell JB, Block PC. Clinical follow-up of patients undergoing percutaneous mitral balloon valvotomy. Circulation. 1995; 91: 671-676. doi: 10.1161/01.CIR.91.3.671
Goswami KC, Bahl VK, Talwar KK, Shrivastava S, Man-chanda SC. Percutaneous balloon mitral valvuloplasty using the Inoue balloon: analysis of echocardiographic and other variables related to immediate outcome. Int J Cardiol. 1999; 68: 261-268. doi: 10.1016/S0167-5273(98)00371-4
Post JR, Feldman T, Isner J, Herrmann HC. Inoue balloon mitral valvotomy in patients with severe valvular and subval-vular deformity. J Am Coll Cardiol. 1995; 25: 1129-1136. doi: 10.1016/0735-1097(94)00063-V
Patel JJ, Shama D, Mitha AS, et al. Balloon valvuloplasty versus closed commissurotomy for pliable mitral stenosis: a prospective hemodynamic study. J Am Coll Cardiol. 1991; 18: 1318-1322. doi: 10.1016/0735-1097(91)90555-N
Lee TM, Su SF, Chen MF, Liau CS, Lee YT. Changes of left ventricular function after percutaneous balloon mitral valvulo-plasty in mitral stenosis with impaired left ventricular perfor-mance. Int J Cardiol. 1996; 56: 211-215.
Reid CL, Otto CM, Davis KB, Labovitz A, Kisslo KB, Mck-ay CR. Influence of mitral valve morphology on mitral balloon commissurotomy: Immediate and six-month results from the NHLBI Balloon Valvuloplasty Registry. Am Heart J. 1992; 124: 657-665.
Reid CL, Chandraratna PA, Kawanishi DT, Kotlewski A, Ra-himtoola SH. Influence of mitral valve morphology on double-balloon catheter balloon valvuloplasty in patients with mitral stenosis. Analysis of factors predicting immediate and 3-month results. Circulation. 1989; 80: 515-524. doi: 10.1161/01. CIR.80.3.515
Padial LR, Freitas N, Sagie A, et al. Echocardiography can predict which patients will develop severe mitral regurgitation after percutaneous mitral valvulotomy. J Am Coll Cardiol. 1996; 27: 1225-1231. doi: 10.1016/0735-1097(95)00594-3
Roberts BJ, Grayburn PA. Color flow imaging of the vena contracta in mitral regurgitation: technical considerations. J Am Soc Echocardiogr. 2003; 16: 1002-1006. doi: 10.1016/S0894- 7317(03)00509-1
Vahanian A. Balloon valvuloplasty. Heart. 2001; 85: 223- 228.
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